HomeMy WebLinkAbout1999-011923 - reside ` PERMIT
� CITY OF ORONO PERMIT TYPE: �C,� .
2750 Kelley Parkway - P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number:
(612) 249-4600 Date Issued:
: ��`�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ :. Y ; _ <_ � OWNER:
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' A PLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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� Total Fee: $ �Q� • 7 5 Date Received: �
Entered By: �/�, Permit#: ��9�?3 �
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER O CONTRACTOR�
JOB SITE ADDRESS: �CP�G �G X S�> ZIP: S S 3�
NAME OF OWNER• �r� e 2 J� r� PHONE: (home) 'Y7(o �'Q 3�
� (work)
MAILING ADDRESS• v��.�G �y -J� CITY: %J� �� ZIP: �s 3�'�
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CONTRACTOR: Cc� J1`t l ��'f I PHONE: �oZ�-9.3 �l �
CONTACT PERSON: c� MOBILE/PAGER: � ( - �r�
MAILING ADDRESS: ,�?7G( a�>Sc'�<< � /���' -5 CITY: �S-� �aY, , ,�%' ZIP: _5:S L( �
STATE LICENSE: # �(�3 �
ARC�IITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration � Land Alteration
PROPOSED WORK(describe in detai�: /'i e �S"r d� `��usc' l� i� � c� �
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STORIES: SQ. FEET O EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. � DET.
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ �,� �i 'i O �� _
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
� the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in accordance �i e a proved�lan.
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' ATURE• ' ` � � ��,' ��. , // DATE• ���Z��� /
APPLICANT S SIGN . /�� -
NOTE! Parade Qf Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SUBJECTS OF D�TA
Subd. 1. Type of data. The rig6ts of individual on whom rhe data is stored or co be stored shall be as se[forrh in rhis secdon.
Subd.2. Informatioo reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)the purpose and ia[ended use of the requesied data wi�hin the collecang'statP a2ency,political subdivision,or sratewide system;
(b)whether he may refuse or is legally required to suppty the reques[ed data:(c)any lrnown consequence arising from his supplying or refusing to supply
private or confidenrial data;and(d)the idenri[y of other persons or ennoes au[horized by state or fed:rai law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdeauve daca, pursuan[to secrion 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of re�enue mav place �he notice reouired under this subdivision in the individual income_tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon requesc to a responsibte au[horiry,an individual shall be informed whether he is the subject
of scored data on individuals, and whe[her it is classified as public, private or confidenrial. Upo�his further request,an individual who is the subjec�
of stored private or public data on individuals shall be shown[he data wichout any charge to hun and, if he desires, shall be informed of the content
and meaning of[hat data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuan[to this section is pending or addinonal dara on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authority
may require the requesring person to pay the actual costs of making, cerafying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comp(y with the request
within that time,he shall so inform the individual,and may have an addivonal five days within which w comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or pm•ate
data concerning himself. To exercise[his rieht,an individual shall notify in wricing[he responsible authoriry describing the nature of the disagreemen[.
The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccucate or incomplete data, including recipiencs named by the individual; or(b)norify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinaaon of the responsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we w�ould like to inform you that your request
for a permit or license from the City of Orono or any of its depar[ments may require you to fumish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2, You may refuse to supply data, but refusal may require that the City deny the permit or license.
3. The information may be shared with other locai, state or federal a�encies to the extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6, Your full name is required to process this application or permit.
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City Stare Zip Phone
I understand my ri hts ated ab e.
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Signature
DATE TIME
CITY OF ORONO CALLED IN e'
INSPECTION NOTICE scHEou�Eo > �'Y �
PERMIT N0. // 9a�3 COMPLETED !C, � �-�
ADDRESS��20 �d]'i
OWNER CONTR.��<<�
TELEPHONE NO. '�!X � ����
� DESCRIPTION ,�,�.��
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 LL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 D M(�-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
fl COMMENTS: �C�t.�2. ,Qr�-i �rw�i��
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� �;WORKSATISFACTORY:PROCEED ,2�IpROJECTCOMPLETE
W �L7 CORRECT WORK 8 PROCEED (C ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. �� pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.473�73�J7
OwnerlContra�or on site:
Inspector.�� �r_t�c.� vl f
White Copy/lnspector's File Canary CopylSite Notice